Page 4 | Crossroads For Life Ministries

Use this form to let us know about decisions or make your request here. Please complete the following fields, then click Submit.

Name (Required)

Email Address (Required)

I am a: (Required)

Please tell us who you are

First Time Guest

Regularly Attend (Not A Member)

Member

Your Name (Required)

Your email address (Required)

Birthday

Gender (Required)

Marital Status

Spouse Name ( Type N/A, if not applicable)

Please list child(ren) name(s) under the age of 18: (Type N/A, if not applicable)

Mailing Address

City

State

Zip Code

My Decision Today: I want to... (Required)

Let us know if you made a decision today or if you want us to follow-up with you.

Commit my life to Jesus

Renew my commitment to Christ

Request to become an E-member

Obtain assistance or be connected with resources

Receive spiritual advisement

Request Baby Dedication

Best Contact Number (Required)

Best Time To Reach You?

Questions? Comments?

Crossroads For Life Ministries